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download form 1-134 affidavit of support pdf

USCIS
Form I-134
Affidavit of Support
Department of Homeland Security
U.S. Citizenship and Immigration Services
OMB No. 1615-0014
Expires 11/30/2018
► START HERE - Type or print in black ink.
Part 1. Information About You (the Sponsor)
Sponsor's Physical Address
Your Full Name
5.a. Street Number
and Name
1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
5.b.
1.c. Middle Name
5.d. State
Apt.
Ste.
Flr.
5.c. City or Town
5.f.
Other Names Used
List all other names you have ever used, including aliases,
maiden name, and nicknames. If you need extra space to
complete this section, use the space provided in Part 7.
Additional Information.
5.e. ZIP Code
Province
5.g. Postal Code
5.h. Country
2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)
6.
2.c. Middle Name
7.a. Town or City of Birth
Other Information
Sponsor's Mailing Address
Date of Birth (mm/dd/yyyy)
7.b. Country of Birth
3.a. In Care Of Name
8.
Alien Registration Number (A-Number) (if any)
► A-
9.
U.S. Social Security Number (if any)

10.
USCIS Online Account Number (if any)

3.b. Street Number
and Name
3.c.
Apt.
Ste.
Flr.
3.d. City or Town
3.e. State
3.f.
ZIP Code
3.g. Province
3.h. Postal Code
3.i.
Country
4.
Are your mailing address and physical address the same?
No
Yes
If you answered "No" to Item Number 4., provide your
physical address in Item Numbers 5.a. - 5.h.
Form I-134 11/30/16 N
Citizenship or Residency or Status
If you are not a U.S. citizen based on your birth in the United
States, or a non-citizen U.S. national based on your birth in
American Samoa (including Swains Island), answer the
following as appropriate:
11.a.
I am a U.S. citizen through naturalization. My
Certificate of Naturalization number is
11.b.
I am a U.S. citizen through parent(s) or marriage.
My Certificate of Citizenship number is
Page 1 of 8
Part 1. Information About You (the Sponsor)
(continued)
11.c.
11.d.
11.e.
I derived my U.S. citizenship by another method.
(Provide an explain in Part 7. Additional
Information.)
8.a. Street Number
and Name
Apt.
8.b.